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PPHR Frequently Asked Questions

These frequently asked questions are selected from records of questions received by PPHR state leads and NACCHO staff since the beginning of the PPHR project. They cover inquiries related to the PPHR application and review processes. If you have any additional questions not answered here, please contact NACCHO staff at pphr@naccho.org.

Q: What is the value to a local health department (LHD) of being recognized through PPHR?

The PPHR process helps identify strengths and weaknesses in an LHD's public health preparedness plan and provides a framework and resources for improving planning and response capability. Working towards PPHR recognition builds relationships between staff members and partner agencies. PPHR recognition also increases agency visibility and enhances and LHD's credibility in the preparedness community.

The PPHR criteria are built upon a continuous quality improvement process that links planning, training, and a demonstration of readiness through exercises or real events.

After enhancing their all-hazards plan to meet national standards (Measure 1), LHDs conduct a training needs assessment to determine the extent to which their staff can carry out their responsibilities (Measure 2). The priority training needs identified by the assessment are used to inform the workforce development plan (Measure 3) and the exercise plan (Measure 5). Evaluations from exercises and responses to real events (Measure 4) are used to revise and update the all-hazards plan, workforce development plan, and exercise plan.

Q: How does PPHR compare to other local public health standards-based programs?

The PPHR criteria address preparedness and response at the local level, specifically in planning, training, and demonstration of readiness.

CDC's public health preparedness (PHEP) capabilities assist planners at both the state and local level in identifying gaps, determining priorities, and developing plans for building and sustaining capabilities.

PPHR has strong alignments with both of these programs, and documentation developed for PPHR can assist LHDs with meeting their standards. For more information, please visit our page on Alignment with National Programs.

As a potential applicant: Steps for starting the program are available on our overview page. Applying agencies must be located in a state that participates in the PPHR state-supported model. Each participating state has a state lead whom you can contact for guidance on becoming involved with the program. More information on the state-supported model and state-lead contact information is available here. If your state does not yet participate in the state-supported model, e-mail pphr@naccho.org to explore next steps.

Other eligibility guidelines for interested agencies are detailed here. Agencies at the district or regional level can be eligible to apply if they are responsible for most response functions at the local level. For questions about the eligibility of regional agencies please e-mail pphr@naccho.org.

As a previously recognized agency: Agencies that are currently PPHR-recognized may apply for re-recognition if even if they are not located in a state that participates in the state-supported model, as long as their PPHR recognition has not expired. Please e-mail pphr@naccho.org for more information regarding re-recognition.

As an interested state: State health departments or SACCHOs can become leaders and coordinate applications for agencies within their state. More information on the PPHR state-supported model is available here. To learn more, please e-mail pphr@naccho.org.

As an interested National Reviewer: If you have a strong understanding of public health preparedness and response, consider becoming a National Reviewer. NACCHO periodically seeks a diverse group of local public health preparedness professionals to volunteer to review PPHR applications. Please visit our national reviewers page for more information.

1. Read through the requirements of the criteria before starting. As you work on one goal, you will be able to identify information to use for the other two goals.

2. Use the PPHR Gap Analysis Tool to identify evidence elements in the criteria for which your department may not currently have plans or documentation to provide as evidence. Be mindful of the allowable time windows for documentation in Goals 2 and 3. If these documents do not fall within the required timeframes, they are not valid for the purposes of the application, and development of new or updated documentation may require significant time.

3. Begin working early on any element for which you are not the lead agency and any elements for which significant gaps exist.

4. Ensure that your agency has software to convert documents to PDF and assemble applications (see the Current Applicants Page for instructions).

Q: What resources are available to help my agency develop content to meet the criteria?

The PPHR Toolkit has many resources and best practices to assist agencies with improving their plans. NACCHO staff members also have other resources and advice to share. NACCHO recommends the resources in the Advances Practice Centers (APC) toolkit, as well. More information is available on the Current Applicants Page.

Q: Does all the evidence used to meet the PPHR criteria have to be in the agency's emergency plan, or are other kinds of documentation allowed?

PPHR recognizes that plans must be usable and that giant planning documents can become unwieldy.. If a criteria element asks for evidence "in the plan," then the evidence should be located in a plan or plan annex. If the criteria element asks for evidence "in the application," then the evidence can be located in other kinds of documentation. If an element contains an asterisk, the evidence does not have to be in a plan, as long as the plan states where it can be found.

An applicant only needs to hyperlink reviewers to one location of evidence for each criteria element. More hyperlinks to additional documents are optional if necessary to demonstrate that the applicant has met the criteria. Applicants are encouraged to include only the strongest evidence to meet each element, which means that normally, more than f should not require more than five links. Additional guidance the links should be listed in order of importance. It is recommended not to exceed three links unless absolutely necessary. It is also recommended that each hyperlink not refer to more than five pages of a plan or other application document. Longer sections make it more difficult for reviewers to locate and assess the evidence for a given criteria element.

Q: What information does an LHD need to provide if it is not the lead agency for a particular evidence element? Does the evidence need to include a copy of the lead agency's plan?

If the LHD is not the lead agency for a particular criteria element, the applicant must provide a description that includes the following:

Identification of the lead agency;

Description of the roles and responsibilities of the lead agency;

Description of the support roles and responsibilities of the applicant;

Description of how the applicant partners with the lead agency to plan for, and prepare to deliver, the emergency service addressed in the evidence element;

Description of the applicant's coordination and communication process for supporting the work of the lead agency;

Description of how the applicant will work with the lead agency during and/or following an emergency response;

An example of how this has worked in the past, how it was exercised, or how it is addressed in the workforce development plan; and

If applicable, description of the authority or documentation formalizing the relationship with the lead agency (e.g., mutual aid agreements, contracts, regulatory obligations).

These requirements are also listed under "Application Guideline #1" at the bottom of the PPHR Criteria Crosswalk.

In order to address the lead agency's and the applicant's roles, it will be necessary to incorporate elements from the lead agency's plan into the applicant's plan. While a copy of the lead agency's plan in its entirety may be helpful for certain criteria, a copy of the entire plan is not required.

Q: What happens if an applicant cannot meet a criteria element because they are unable to obtain documentation or complete a planning process by the application deadline?

If there is an criteria element that an applicant has not yet addressed or that documentation is not yet available for, the applicant can still receive partial credit by meeting Application Guideline #2. This requires submission of the following information:

Explanation of why the specific item has not been addressed;

Steps/milestones of a plan to address the item;

Timeline of steps/milestones; and

Listing of partners and description of their responsibilities to address the item.

These requirements are also listed under "Application Guideline #2" at the bottom of the PPHR Criteria Crosswalk.

The highest score an applicant can receive by satisfying Application Guideline #2 is a Partially Met. Applicants that do not complete Application Guideline #2 risk a score of Not Met on a criteria element, which means that they cannot earn PPHR recognition status.

Q: What should the Executive Summary contain and how long should it be?

The purpose of the Executive Summary is to provide background information for reviewers on the applicant's agency and jurisdiction. This is the main source of background information for national reviewers to be able to understand the context in which the applicant responds to emergencies. It is therefore important for this document to provide a complete picture of the applying agency, including its size and resources, to put its response plans into perspective.

A list of bullets at the bottom of the PPHR Criteria Crosswalk describes in more detail the information that should be included in the Executive Summary. While the document is titled "Executive Summary," the reviewers are looking for more of a narrative summary. These documents are usually five to ten pages in length, but are sometimes longer than ten pages. It is generally not advisable to exceed 20 pages in length.

PPHR applications can be assembled in a number of formats, but all consist of a PPHR criteria crosswalk that hyperlinks to specific evidence for each criteria element. Some evidence will be in the agency's all-hazards plan and annexes, and some will be in other kinds of documents. Instructions for preferred application formats are available on the Application Assembly page.

Each application is reviewed by three PPHR national reviewers working as a team. PPHR reviewers are selected for their strong understanding of local public health preparedness and response. Most are local health department personnel and include planners, responders, exercise and training coordinators, and epidemiologists. Qualified candidates from state health departments and other organizations may also serve as reviewers.

All reviewers must attend an orientation and training webinar and complete a training assessment to demonstrate their understanding of the PPHR review process, criteria, and scoring and commenting procedures.

Each criteria element is scored by a review team as Met, Partially Met, or Not Met. An applicant cannot be recognized with a score of Not Met anywhere in the application. A certain number of Partially Mets are allowed, as determined by the PPHR scoring algorithm.